Ask Our Doctors – Archive
Our Medical Directors are outstanding physicians that you will find to be very personable and compassionate, who take care to ensure that you have the most cutting-edge fertility treatments at your disposal. This is your outlet to ask your questions to the doctors.
Hi Dr. Sher,
How long can 250mcg of Ovidrel stay in your system? I’m seeing anywhere from 10-14 days. I would prefer to do an HPT prior to my bloodtest, but I know the risk of a false positive. I know the HPT is discouraged, but clinically speaking, how many days post trigger would I be without great risk of a false positive?
I appreciate your time and expertise! Thank you so much.
About 12-14 days. You can do a HPT after 16 days.
God luck!
Geoff Sher
Hi Dr. Sher:
I’m 37 with no children and have been trying to conceive for a year. I went to a specialist and was told I have premature DOR, with no genetic relation. The plan of action was go with IUI, with 75iu after 3 days blood work showed: Progesterone 0.89 E2 <25.0 Endo: 4.88
I was then upped the dose of Menopur to 150 iu with results 3 days later of: Progesterone: 1.05 E2 28.7 Endo 7.60 followed by 3 more days of Menopur at 150 iu with results of Progesterone 0.76 E2 74.0 LF 11 Endo 5.93 and the last dose of Menopur 150 iu for an additional 3 more days showing results of: Progesterone: 0.52 E2 168.7 LF 14 Endo 8.21 before my final Ovidrel 250 trigger shot 2 days later. I produced one follicle and was wondering if you would have recommended this course of action and what you recommend I do moving forward if IVF is not an option because of cost? I'm feeling hopeless and trying my best to stay positive. Thank you Dr. Sher
Samantha,
I can understand and empathize with you regarding IVF, cost-related issues, but alas, IUI is in my opinion not the right way to go,. given your DOR. You simply do not have the latitude of time. You need IVF.
Here is the protocol I advise for women, <40Y who have adequate ovarian reserve.
My advice is to use a long pituitary down regulation protocol starting on a BCP, and overlapping it with Lupron 10U daily for three (3) days and then stopping the BCP but continuing on Lupron 10u daily (in my opinion 20U daily is too much) and await a period (which should ensue within 5-7 days of stopping the BCP). At that point an US examination is done along with a baseline measurement of blood estradiol to exclude a functional ovarian cyst and simultaneously, the Lupron dosage is reduced to 5U daily to be continued until the hCG (10,000u) trigger. An FSH-dominant gonadotropin such as Follistim, Puregon or Gonal-f daily is started with the period for 2 days and then the gonadotropin dosage is reduced and a small amount of menotropin (Menopur---no more than 75U daily) is added. This is continued until US and blood estradiol levels indicate that the hCG trigger be given, whereupon an ER is done 36h later. I personally would advise against using Lupron in “flare protocol” arrangement (where the Lupron commences with the onset of gonadotropin administration.
I strongly recommend that you visit https://www.drgeoffreysherivf.com. Then go to my Blog and access the “search bar”. Type in the titles of any/all of the articles listed below, one by one. “Click” and you will immediately be taken to those you select. Please also take the time to post any questions or comments with the full expectation that I will (as always) respond promptly.
• The IVF Journey: The importance of “Planning the Trip” Before Taking the Ride”
• Controlled Ovarian Stimulation (COS) for IVF: Selecting the ideal protocol
• IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation (COS)
• The Fundamental Requirements For Achieving Optimal IVF Success
• Use of GnRH Antagonists (Ganirelix/Cetrotide/Orgalutron) in IVF-Ovarian Stimulation Protocols.
• Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
• Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas
• Should IVF Treatment Cycles be provided uninterrupted or be Conducted in 7-12 Pre-scheduled “Batches” per Year
• A personalized, stepwise approach to IVF
• “Triggering” Egg Maturation in IVF: Comparing urine-derived hCG, Recombinant DNA-hCG and GnRH-agonist:
If you are interested in seeking my advice or services, I urge you to contact my concierge, Julie Dahan ASAP to set up a Skype or an in-person consultation with me. You can also contact Julie by phone or via email at 702-533-2691/ Julied@sherivf.com You can also apply online at http://www.SherIVF.com .
*FYI
The 4th edition of my newest book ,”In Vitro Fertilization, the ART of Making Babies” is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.
Geoffrey Sher MD
Hi Dr,
I posted yesterday about the spotting i was facing. I consulted my gynaecologist and she gave duphaston 10mg a week before and now she is asking me to take transamine 500 mg twice a day. Is it safe to have these both at the same time ?
Respectfully, I have no idea why you would be prescribed an antifibrinolytic agent such as Transamine. I have never heard of it being used in this setting.
Geoff Sher
Geoff Sher
Hi Dr Sher
We had 5 blastocysts and all tested PGS abnormal chromosomes. We have none for FET. Doctor is telling us they were so bad that she ethically won’t try IVF again with us. She said problem is with both of us. We are in our late 20s with egg/sperm problems. We did ICSI and were able to fertilize 12 with 5 blastocysts. Doctor said even a donor egg wouldn’t work. Doctor said, both my husband and I are not genetically made to have biological children. Is there any hope for us?
Very respectfully Lena, if that is what you were told, I cannot agree. At age 20y, you should not respond with uniformly abnormal embryos. This sounds very much like an ovarian stimulation issue, in my opinion.
Here is the protocol I advise for women, <40Y who have adequate ovarian reserve.
My advice is to use a long pituitary down regulation protocol starting on a BCP, and overlapping it with Lupron 10U daily for three (3) days and then stopping the BCP but continuing on Lupron 10u daily (in my opinion 20U daily is too much) and await a period (which should ensue within 5-7 days of stopping the BCP). At that point an US examination is done along with a baseline measurement of blood estradiol to exclude a functional ovarian cyst and simultaneously, the Lupron dosage is reduced to 5U daily to be continued until the hCG (10,000u) trigger. An FSH-dominant gonadotropin such as Follistim, Puregon or Gonal-f daily is started with the period for 2 days and then the gonadotropin dosage is reduced and a small amount of menotropin (Menopur---no more than 75U daily) is added. This is continued until US and blood estradiol levels indicate that the hCG trigger be given, whereupon an ER is done 36h later. I personally would advise against using Lupron in “flare protocol” arrangement (where the Lupron commences with the onset of gonadotropin administration.
I strongly recommend that you visit https://www.drgeoffreysherivf.com. Then go to my Blog and access the “search bar”. Type in the titles of any/all of the articles listed below, one by one. “Click” and you will immediately be taken to those you select. Please also take the time to post any questions or comments with the full expectation that I will (as always) respond promptly.
• The IVF Journey: The importance of “Planning the Trip” Before Taking the Ride”
• Controlled Ovarian Stimulation (COS) for IVF: Selecting the ideal protocol
• IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation (COS)
• The Fundamental Requirements For Achieving Optimal IVF Success
• Use of GnRH Antagonists (Ganirelix/Cetrotide/Orgalutron) in IVF-Ovarian Stimulation Protocols.
• Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
• Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas
• Should IVF Treatment Cycles be provided uninterrupted or be Conducted in 7-12 Pre-scheduled “Batches” per Year
• A personalized, stepwise approach to IVF
• “Triggering” Egg Maturation in IVF: Comparing urine-derived hCG, Recombinant DNA-hCG and GnRH-agonist:
If you are interested in seeking my advice or services, I urge you to contact my concierge, Julie Dahan ASAP to set up a Skype or an in-person consultation with me. You can also contact Julie by phone or via email at 702-533-2691/ Julied@sherivf.com You can also apply online at http://www.SherIVF.com .
*FYI
The 4th edition of my newest book ,”In Vitro Fertilization, the ART of Making Babies” is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.
Geoffrey Sher MD
Hi, Dr. Scher. I have had six IVF transfers, two resulting in BO, two chemicals, two negatives. Just this month I conceived naturally after my second excision lap that also resulted in Chemical. I am under the care of a reproductive immunologist, and we seem to have gotten my immune system under control. If my immune system is not causing these recent chemicals, do you think I have an egg quality issue? Will I continue to have chemicals or will I eventually find an egg that’ll stick/ With this many early losses and never reaching a heart beat, does this sound like a chromosone issue? What would be your advise for me?